title: Clinical outcomes with rapid detection of methicillin-resistant and methicillin-susceptible Staphylococcus aureus isolates from routine blood cultures.
abstract: Staphylococcus aureus is a common cause of bacteremia, with a substantial impact on morbidity and mortality. Because of increasing rates of methicillin-resistant Staphylococcus aureus, vancomycin has become the standard empirical therapy. However, beta-lactam antibiotics remain the best treatment choice for methicillin-susceptible strains. Placing patients quickly on the optimal therapy is one goal of antimicrobial stewardship. This retrospective, observational, single-center study compared 33 control patients utilizing only traditional full-susceptibility methodology to 22 case patients utilizing rapid methodology with CHROMagar medium to detect and differentiate methicillin-resistant and methicillin-susceptible Staphylococcus aureus strains hours before full susceptibilities were reported. The time to targeted therapy was statistically significantly different between control patients (mean, 56.5 ± 13.6 h) and case patients (44.3 ± 17.9 h) (P = 0.006). Intensive care unit status, time of day results emerged, and patient age did not make a difference in time to targeted therapy, either singly or in combination. Neither length of stay (P = 0.61) nor survival (P = 1.0) was statistically significantly different. Rapid testing yielded a significant result, with a difference of 12.2 h to targeted therapy. However, there is still room for improvement, as the difference in time to susceptibility test result between the full traditional methodology and CHROMagar was even larger (26.5 h). This study supports the hypothesis that rapid testing plays a role in antimicrobial stewardship by getting patients on targeted therapy faster.
authors.affiliation: UNC Health Care, Department of Pharmacy, Chapel Hill, North Carolina, USA.
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Nicolsen
authors.forename: Nicholas
authors.initials: N
authors.lastname: LeCroy
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lecroy
authors.forename: Kevin
authors.initials: K
authors.lastname: Alby
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Martin
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Laux
authors.forename: Feng-Chang
authors.initials: FC
authors.lastname: Lin
authors.forename: Lindsay
authors.initials: L
authors.lastname: Daniels
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Miller
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D001431:Bacteriological Techniques / Q000379:methods*; D001769:Blood / Q000382:microbiology*; D003470:Culture Media / Q000737:chemistry; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D003470:Culture Media